MEDICARE: DR. BARBARA FONTANA PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	5854	NY
2	103T00000X	Psychologist	5854	NY

General Provider Information

NPI Number	:	1215039904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA FONTANA PH.D.

Provider Business Mailing Address
First Line	:	45 ROUTE 25A
Second Line	:	STE A2
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-821-1880
Fax Number	:	631-821-4750

Provider Business Practice Location Address
First Line	:	45 ROUTE 25A
Second Line	:	STE A2
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1389
Country	:	US
Telephone Number	:	631-821-1880
Fax Number	:	631-821-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	01/28/2011

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